International Student T ravelers and Gender Concerns: A Brief - PDF document

6/19/2019 International Student T ravelers and Gender Concerns: A Brief Overview CATHERINE EBELKE PA-C, CTH CISTM 16 Greetings from Montana State WASHINGTON DC 7 JUNE 2019 University! 1 2 Underappreciated yet crucial What we’ll discuss in this session LGBTQI+  Gender-related concerns often not discussed – in travel or other appointments  Profound impacts on travel health and safety - and on life in general  Definitions  T ravel (and non-travel) considerations  Not a huge time investment to include in travel discussion  Health challenges in this population  Important opportunity too often missed  Risks with International T ravel  Excellent resources available for students and providers  College T ravel Health possibilities for the LGBTQI+ traveler  We are in a position in conducting a travel consult or teaching an  Resources International T ravel Health and Safety Class to open doors and have a  Broader context and perspective will be addressed positive impact – traveling or not traveling  We do not need to be experts….we can open the door and start the dialog  We won’t be discussing the Solo Female T raveler or related concerns due to time constraints…but great resources are available for that! and offer resources…do not let that inhibit us from asking and caring 3 4 5 6 1

6/19/2019 T erminology / Definitions  Can be confusing but very important to understand working with students – and others!  It is respectful – and essential – to have good working knowledge of current terminology  However, don’t let terminology be a barrier to opening a discussion…we are all continually learning…..and many terms are continually changing  Resources abound to help us all learn more  Many colleges offer or mandate training such as Safe Zone Project 7 8 Basic T erminology / Definitions LBGTQI+  L – Lesbian  G – Gay  B – Bisexual  T – T ransgender  Q - Queer or Questioning  I – Intersex  + - includes multiple other identities often considered too numerous to delineate 9 10 11 12 2

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6/19/2019 25 26 27 28 Identifying as LGBTQI+ has broad and far-reaching significance on many levels  Global  Community  Local  Personal 29 30 5

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6/19/2019 Identifying as LGBTQI+ has broad and far-reaching significance  Personal  Local  Community  Global 37 38 39 40 What is going on at home for Issues at home…. US LGBTQI+ students ? Become issues while traveling….. Stunning report from the CDC …..often with greater risks and higher stakes  High School students …..and little if any support or community  2007 – 2017 data  Very relevant to our populations 41 42 7

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6/19/2019 61 62 63 64 Many resources available  To all types of providers  Medical  Mental Health  Others  Many are excellent  Many are free  More openness in this discussion is crucial – and we can play a role with our traveling students! 65 66 11

6/19/2019 67 68 So, Let’s T alk T raveling Students!  As with all of T ravel Health, advance planning makes a world of difference !  Discussions with Study Abroad re good destination options  Discussions with Health Care Provider, CPS, etc  Excellent communication plans in advance  As with providing T ravel Health care in our college settings, this can be an excellent opportunity to address student health and wellbeing in many ways beyond travel issues 69 70 71 72 12

6/19/2019 73 74 Destination Choice is Critical for this population 75 76 77 78 13

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6/19/2019 For Which Destinations? All! T ravel Consult  An opportunity to open doors  Potentially valuable if traveling or not  Possibility to initiate discussions  Good possibility that support would be very helpful and has not been sought  opportunity to provide resources as well  consider and evaluate itinerary regarding orientation  consider wisdom of travels if in questioning or active transition 91 92 T ravel Consult As an example of one approach, here are a few items from our ASK ! T ravel Health Questionnaire, completed in advance online Open the door 93 94 PHQ : Included with every T ravel Health Questionnaire 95 96 16

6/19/2019 Other important things to cover in the Mental Health history very important as well T ravel Consult Occasionally not disclosed, but often opens important dialogue opportunities…..  Travel Health Questionnaire answers  Receiving regular care anywhere?  Appointments with regular providers – PCP , specialists, MH to discuss travels  If Transgender and actively transitioning  Many additional considerations  Must arrange appointments with regular providers well in advance  Meds?  Injectables?  Monitoring?  Leaving support community at home? 97 98 More T ravel Consult Thoughts More T ravel Consult Thoughts  Always leaving the door open for changing plans is important  Provide a welcoming, respectful and safe environment  Destination changes  Encourage and enable open communication  Delaying or canceling travels  Provide direct and appropriate information  Wherever you go there you are……T aking care of business at home first  Travel as an escape?  Provide resources  Referrals and recommendations as appropriate  on campus  Excellent plans for communication and support – multiple options important  in community  WhatsApp (not in China) – preload contacts national and international   Skype  for travel  Email  Provide answers to questions or offer to facilitate learning answers  ? Phone use  Leave the door open for another appointment and future communication 99 100 Risks Risks Sexual activity while traveling  Violence  Frequency of sex and numbers of partners usually increases abroad  Interpersonal (multiple studies from multiple countries)  Social  STD Risks  Sexual assault  Hooking Up  Apps make this much easier now (Tinder, Grindr,etc)  Substance use  Newly found freedom  Mental health issues  Not constrained by friends, family, community or expectations / assumptions at home  Isolation  Anonymity  Discrimination  Discuss and counsel re risks  Others  Intimate partner violence risk  Increased substance use may also be present  Be open and honest when discussing  Legal and cultural risks 101 102 17

6/19/2019 Additional Related Considerations Additional Related Considerations Bringing condoms from home – may increase use   PrEP? Good opportunity to discuss with certain populations…. Importance of protection must be emphasized  Traveling or not! Inconsistent use   PEP? Frequency of sex and numbers of partners usually increases  abroad (multiple studies from multiple countries)  Healthcare resources abroad HIV   ISTM, IAMAT , Embassies Hepatitis B – complete full series, check titer   Rx availability and quality Hepatitis C   Appropriate evaluation including sample sourcing and timing Potential for higher endemic HIV, Hep B and Hep C rates on  of testing travels GC, CT  STEP and Emergency planning  Syphilis   Discussion in advance of travel is optimal! Zika  103 104 Finding Support Abroad Non-Academic T ravel  How to reach students to invite for appointment?  Medical  Often “just going to Europe” it often does not cross their  Emotional mind to seek a travel consult  May involve higher risk activities  Mental Health  Gay Pride Festival travels  Community  T ravels directly related to sex tourism or greater opportunities  Advance knowledge very helpful  Many missed opportunities for education and discussions that could be significant for all concerned 105 106 Practical Concerns to Discuss  Roommate  Homestay  Group travel  Cultural considerations  TSA and other security  Finding restrooms and other facilities  Sensitive / exposed situations 107 108 18

6/19/2019 109 110 111 112 RESOURCES for our students ABOUND!!!! 113 114 19

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6/19/2019 Many university websites have excellent info Great youtube from Univ of Minnesota https://www.youtube.com/watch?v=U-a93xd7SxY&feature=youtu.be 127 128 Michigan State University 129 130 Michigan State University 131 132 22

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6/19/2019 Thank You !!! Catherine Ebelke PA-C, CTH Montana State University cebelke@montana.edu 151 26